Patient Education

What is an Arrhythmia?
An arrhythmia is an abnormal rhythm of the heartbeat. Although
it can be harmless, an arrhythmia usually indicates a serious
problem that can lead to disability or death.

What is Atrial Fibrillation?
Atrial fibrillation is the most common type of arrhythmia. It is a heart rhythm disorder in which the atria (upper chambers of the heart) quiver erratically instead of beating at a regular rate. Normally, the right atrium's sinoatrial (SA) node, often called the "pacemaker" of the heart, sends systematic electrical impulses to the ventricles (lower chambers of the heart). This causes them to contract. However, when atrial fibrillation occurs, the electrical impulses chaotically travel throughout the atria instead of moving on a straight path toward the ventricles. When the electrical activity finally leaves the atria, the excessive electricity causes the ventricles to rapidly contract. This can result in a faster than normal heartbeat.

What Causes Atrial Fibrillation?
The most common cause of atrial fibrillation is aging. While in many cases, the causes are not known, doctors have identified abnormalities in the heart valves and family history as contributors to atrial fibrillation. Health conditions associated with atrial fibrillation include:

• high blood pressure
  

• heart disease

• heart valve disease
  

• thyroid disorders
  

• lung disease
  

• congestive heart failure
  

• congenital heart defects
  

• blood clot in the lungs

• infection

• electrolyte imbalances

• cardiomyopathy

• heart stimulants/irritants (caffeine, tobacco, alcohol)

What are the Symptoms?
Common signs of atrial fibrillation include:

• palpitations, or heart racing
  

• dizziness, or fainting
  

• chest discomfort, pain or tightness
  

• shortness of breath
  

• decreased energy
  Remember, some people who have atrial fibrillation
  experience no symptoms at all.

Are There Complications with Atrial Fibrillation?
Yes. When the heart rate is too fast, or too slow, dizziness and fainting can occur. Stroke is a complication caused by blood clots that can form due to abnormal blood flow through the atrium. Atrial fibrillation can also begin a weakening of the heart, causing heart failure.

How is Atrial Fibrillation Diagnosed?
After using a stethoscope to detect an arrhythmia, a physician confirms atrial fibrillation by performing a standard electrocardiogram (ECG or EKG). He or she often uses a Holter Monitor device, chest x-ray and blood work to determine if an irregular heartbeat exists. If so, the doctor will verify what kind of arrhythmia is present, how long it lasts and the cause of the abnormal heart rhythm.

What are the Current Treatment Options for Atrial Fibrillation?
Successful treatment restores normal heart rhythm, controls the heart rate, and prevents blood clots and strokes. Treatment options depend on the cause of atrial fibrillation. Conservative options include medication and lifestyle changes. These treatments are prescribed to convert, or maintain normal sinus rhythm; control the heart rate; and prevent blood clots.

• Beta blockers

• Calcium channel blockers

• Anti-arrhythmia drugs

• Blood thinners

• Reduce, or stop, use of caffeine,
  tobacco and amount of stress
  

Patients may also choose from various device therapies and procedures:

• Maze procedure

• pacemaker

• cardioverter defibrillator

• cardiac resynchronization therapy

• catheter ablation
  

Maze Procedure
What is the Maze Procedure?
The Maze procedure is a highly effective surgical option to cure atrial fibrillation. During the procedure, the surgeon makes multiple incisions in both atria (top chambers of the heart) to form a path, or "maze," through which the SA node's electrical impulses will travel. As the heart heals, scar tissue forms around the incisions. This blocks the electrical activity from traveling throughout the atria. The redirected impulses then move toward the ventricles on a fixed path. The Maze procedure is often performed in conjunction with mitral valve or other cardiac surgery.

Who Performs the Procedure?
Because the Maze procedure requires incisions inside the heart and along the sternum (breast bone), a cardiothoracic surgeon performs
the surgery.

Am I a Candidate for Surgery?
Many patients experience adequate relief from atrial fibrillation through medications or less-invasive procedures. However, some cases are cured only with surgery.
You may be a candidate for the Maze procedure if:

• Medications don't correct your arrhythmia
  

• You are at high risk for embolic events such as blood
  clots/strokes.
  

• Your left atrium has been enlarged for more than six months.
  

• You already plan to undergo mitral valve or other cardiac surgery.
  

What is the Recovery Period?
Immediately following surgery, patients typically spend 24 hours in the Intensive Care Unit and then are moved to a regular hospital room. Most patients stay in the hospital about five to seven days after the traditional Maze procedure, depending on the course of recovery. Although recovery periods vary depending on the person, most patients remain at the hospital for 5 to 7 days after conventional openheart surgery; and 2 to 3 days for a closed-chest surgery. During the six to eight weeks following the procedure, you will gradually gain energy and strength. After three months, you should operate at 80 to 90 percent of your regular energy level. After six months, you should be back to normal. You may facilitate recovery by following a cardiac rehabilitation program, which includes walking and other exercise.

What is the Success Rate?
The Maze procedure is successful in 80 percent of atrial fibrillation cases. Because the surgery causes short-term inflammation of the atrial tissue, about 30 percent of patients experience temporary atrial fibrillation after surgery. After the heart heals, normal heart rhythm returns, making medication no longer necessary.

Are There Any Side Effects to this Procedure?
A small percentage of patients require a pacemaker or other drugs to maintain normal rhythm. Some patients may need to take a diuretic to treat post-operative fluid retention. If atrial fibrillation is present after surgery, medications may be used to help control
the abnormal rhythm.

Risks to this procedure are generally low and vary depending whether the operation is performed with the minimally invasive technique or with the open-heart approach. Risks may be increased in patients with other medical problems. Other complications common in any open-heart surgery include bleeding, wound infection, stroke, pneumonia, organ failure, and even death.

Can My Condition Be Treated Non-Surgically?
Some cases of atrial fibrillation may respond to various drugs designed to restore normal heart rhythm, control ventricular rate and prevent blood clot formation. More serious cases may require treatments such as electrical cardioversion, catheter ablation, pacemakers and atrial defibrillators. However, these treatments are sometimes unsuccessful. In such cases, the Maze procedure may cure the problem by eliminating the arrhythmia, renewing synchrony between the atria and ventricles, and maintaining orderly atrial contraction.